Intraoperative assessment of in situ saphenous vein bypass grafts by vascular endoscopy.

Intraoperative vascular endoscopy was used in 20 femorocrural in situ saphenous vein bypass procedures in order to control valvular incompetence, to localize side branches and to assess the integrity of the distal anastomosis. We used an Olympus Fiberscope (PF-27L) with a diameter of 2.7 mm and a working length of 80 cm, which had fixed illuminating and viewing fibers and a steerable tip, Valvulotomy was performed according to the technique described by R. Leather using a valve-cutter. In 8 out of 20 patients, partly retained valve leaflets were found by intraluminal inspection and could be immediately corrected. The integrity of the distal anastomosis was verified angioscopically in 14 patients. In addition, venous side branches, which had to be ligated, were easily identified under direct vision and localized by transillumination of the endoscopic light through the skin. Vascular endoscopy seems to be a practicable and time saving method to control in situ vein bypass procedures. The steps of the procedure and early results after 20 bypasses for limb salvage are presented.